{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:41:02Z","timestamp":1790250062214,"version":"4.1.0"},"reference-count":207,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Malnutrition afflicts millions of the world\u2019s children and predisposes to death from diarrhea and infectious diseases. Children with severe acute malnutrition (SAM) are at highest risk. Our review of the endocrinology and metabolomics of SAM implicates critical roles for white adipose tissue and its regulatory hormones and growth factors in the adaptation to nutritional deprivation and the restoration of metabolic homeostasis: white adipose provides substrates and energy for hepatic glucose production and cardiopulmonary and central nervous system function, and products of fat metabolism inhibit muscle glucose uptake and utilization and spare muscle protein. Collectively, these effects maintain glucose availability for the brain, red blood cells, and renal medulla and conserve muscle mass. White adipose tissue also secretes leptin, which facilitates the immune response and may protect against mortality from infection. Euglycemia and survival in SAM are thereby prioritized over linear growth, which is suppressed owing to inhibition of insulin-like growth factor 1 production and action. Diversion of energy from growth serves to maintain essential bodily functions in critically ill malnourished children, who have limited energy reserves. Thus, short-term reductions in growth rate have adaptive benefits in SAM. Under favorable conditions, clinical and metabolic recovery are accompanied by catch-up growth, which can mitigate, and in many cases reverse, the stunting of growth in childhood. Nevertheless, clinical recovery can be complicated by preferential accrual of central fat and a relative deficiency of lean\/skeletal mass, with potential long-term complications including insulin resistance, glucose intolerance, and metabolic syndrome.<\/jats:p>","DOI":"10.3390\/nu17172864","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T09:18:57Z","timestamp":1756977537000},"page":"2864","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Adaptive Responses in Severe Acute Malnutrition: Endocrinology, Metabolomics, Mortality, and Growth"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6477-9258","authenticated-orcid":false,"given":"Laura","family":"Page","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology, Duke University Medical Center, 3000 Erwin Road, Durham, NC 27005, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"McCain","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Duke University Medical Center, 3000 Erwin Road, Durham, NC 27005, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5123-3531","authenticated-orcid":false,"given":"Michael","family":"Freemark","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Duke University Medical Center, 3000 Erwin Road, Durham, NC 27005, USA"},{"name":"Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"ref_1","first-page":"94","article-title":"Volume III: The Late Period \u201cSee the translation of the Famine Stela (~200 BCE)\u201d","volume":"Volume 3","author":"Lichtheim","year":"1973","journal-title":"Ancient Egyptian Literature: A Book of Readings"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ekeng, B., Adedokun, O., Otu, V., Chukwuma, S., Okah, A., Asemota, O., Eshiet, U., Akpan, U., Nwagboso, R., and Ebiekpi, E. (2024). The Spectrum of Pathogens Associated with Infections in African Children with Severe Acute Malnutrition: A Scoping Review. Trop. Med. Infect. Dis., 9.","DOI":"10.3390\/tropicalmed9100230"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S0140-6736(14)61698-6","article-title":"Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: An updated systematic analysis","volume":"385","author":"Liu","year":"2015","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/S0140-6736(13)60222-6","article-title":"Global burden of childhood pneumonia and diarrhoea","volume":"381","author":"Walker","year":"2013","journal-title":"Lancet"},{"key":"ref_5","unstructured":"World Health Organization, United Negro College Fund, International Bank for Reconstruction and Development, and Development\/The World Bank Group (2023). Levels and Trends in Child Malnutrition: UNICEF\/WHO\/World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2023 Edition."},{"key":"ref_6","first-page":"2543","article-title":"Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: A systematic analysis for the Global Burden of Disease Study 2021","volume":"404","year":"2025","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17067","DOI":"10.1038\/nrdp.2017.67","article-title":"Severe childhood malnutrition","volume":"3","author":"Bhutta","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.4103\/jfmpc.jfmpc_211_20","article-title":"Risk factors for severe acute malnutrition among children aged 6\u201359 months: A community-based case-control study from Vellore, Southern India","volume":"9","author":"David","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e20160641","DOI":"10.1542\/peds.2016-0641","article-title":"Environmental Enteric Dysfunction and Growth Failure\/Stunting in Global Child Health","volume":"138","author":"Owino","year":"2016","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/QCO.0000000000000261","article-title":"Interactions between intestinal pathogens, enteropathy and malnutrition in developing countries","volume":"29","author":"Prendergast","year":"2016","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/S0147-9563(99)70028-2","article-title":"Anorexia in response to acute illness","volume":"28","author":"Lennie","year":"1999","journal-title":"Heart Lung"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"156035","DOI":"10.1016\/j.metabol.2024.156035","article-title":"Starvation and infection: The role of sickness-associated anorexia in metabolic adaptation during acute infection","volume":"161","author":"Jindal","year":"2024","journal-title":"Metabolism"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1210\/jc.2013-4018","article-title":"Severe acute malnutrition in childhood: Hormonal and metabolic status at presentation, response to treatment, and predictors of mortality","volume":"99","author":"Bartz","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.3945\/ajcn.110.004564","article-title":"The effects of iron fortification on the gut microbiota in African children: A randomized controlled trial in Cote d\u2019Ivoire","volume":"92","author":"Zimmermann","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100866","DOI":"10.1016\/j.blre.2021.100866","article-title":"The critical roles of iron during the journey from fetus to adolescent: Developmental aspects of iron homeostasis","volume":"50","author":"Donker","year":"2021","journal-title":"Blood Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1080\/15548627.2016.1147672","article-title":"Autophagy\u2014A free meal in sickness-associated anorexia","volume":"12","author":"Loos","year":"2016","journal-title":"Autophagy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1098\/rspb.1962.0074","article-title":"Protein metabolism in human protein malnutrition","volume":"156","author":"Waterlow","year":"1962","journal-title":"Proc. R. Soc. Lond. B Biol. Sci."},{"key":"ref_18","first-page":"72","article-title":"The relative roles of protein and energy deficiency in the pathogenesis of protein-energy malnutrition","volume":"23","author":"Whitehead","year":"1979","journal-title":"Z. Ernahrungswiss Suppl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1179\/146532808X302107","article-title":"Protein metabolism in severe childhood malnutrition","volume":"28","author":"Jahoor","year":"2008","journal-title":"Ann. Trop. Paediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/0035-9203(88)90245-3","article-title":"The effects of malnutrition in the metabolism of children","volume":"82","author":"Golden","year":"1988","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/S0140-6736(82)92839-2","article-title":"Protein deficiency, energy deficiency, and the oedema of malnutrition","volume":"1","author":"Golden","year":"1982","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1093\/ajcn\/67.6.1205","article-title":"Whole-body protein kinetics in marasmus and kwashiorkor during acute infection","volume":"67","author":"Manary","year":"1998","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_23","first-page":"2102","article-title":"Growth and growth hormone in protein calorie malnutrition","volume":"46","author":"Pimstone","year":"1972","journal-title":"S. Afr. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0022-3476(75)80608-1","article-title":"Energy metabolism and hormonal profile in children with edematous protein-calorie malnutrition","volume":"87","author":"Parra","year":"1975","journal-title":"J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1079\/BJN19730117","article-title":"Progressive changes in serum cortisol, insulin and growth hormone concentrations and their relationship to the distorted amino acid pattern during the development of kwashiorkor","volume":"29","author":"Lunn","year":"1973","journal-title":"Br. J. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1203\/00006450-197705000-00003","article-title":"A comparison of fasting plasma insulin and growth hormone concentrations in marasmic, kwashiorkor, marasmic-kwashiorkor and underweight children","volume":"11","author":"Robinson","year":"1977","journal-title":"Pediatr. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/ajcn\/25.5.499","article-title":"Patterns of insulin response to glucose in protein-calorie malnutrition","volume":"25","author":"Becker","year":"1972","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"336S","DOI":"10.1093\/jn\/133.1.336S","article-title":"The history of nutrition: Malnutrition, infection and immunity","volume":"133","author":"Keusch","year":"2003","journal-title":"J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e13856","DOI":"10.1111\/obr.13856","article-title":"Branched-chain amino acid metabolism: Pathophysiological mechanism and therapeutic intervention in metabolic diseases","volume":"26","author":"Mansoori","year":"2025","journal-title":"Obes. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11306-016-1150-2","article-title":"Metabolic derangements identified through untargeted metabolomics in a crosssectional study of Nigerian children with severe acute malnutrition","volume":"13","author":"McMillan","year":"2016","journal-title":"Metabolomics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"eaau4732","DOI":"10.1126\/science.aau4732","article-title":"Effects of microbiota-directed foods in gnotobiotic animals and undernourished children","volume":"365","author":"Gehrig","year":"2019","journal-title":"Science"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1203\/00006450-198611000-00012","article-title":"Serum insulin-like growth factors I and II concentrations and growth hormone and insulin responses to arginine infusion in children with protein-energy malnutrition before and after nutritional rehabilitation","volume":"20","author":"Soliman","year":"1986","journal-title":"Pediatr. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1046\/j.1523-1755.2002.00603.x","article-title":"Differential effects of insulin-like growth factor binding proteins-1, -2, -3, and -6 on cultured growth plate chondrocytes","volume":"62","author":"Kiepe","year":"2002","journal-title":"Kidney Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/endo.142.5.8149","article-title":"Growth inhibition in giant growth hormone transgenic mice by overexpression of insulin-like growth factor-binding protein-2","volume":"142","author":"Hoeflich","year":"2001","journal-title":"Endocrinology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4116","DOI":"10.1128\/MCB.01011-12","article-title":"Insulin-like growth factor (IGF) binding protein 2 functions coordinately with receptor protein tyrosine phosphatase beta and the IGF-I receptor to regulate IGF-I-stimulated signaling","volume":"32","author":"Shen","year":"2012","journal-title":"Mol. Cell Biol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.bone.2005.07.024","article-title":"Role of IGFBP2, IGF-I and IGF-II in regulating long bone growth","volume":"37","author":"Fisher","year":"2005","journal-title":"Bone"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1093\/advances\/nmaa138","article-title":"Dysglycemia in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis","volume":"12","author":"Ledger","year":"2021","journal-title":"Adv. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wen, B., Brals, D., Bourdon, C., Erdman, L., Ngari, M., Chimwezi, E., Potani, I., Thitiri, J., Mwalekwa, L., and Berkley, J.A. (2021). Predicting the risk of mortality during hospitalization in sick severely malnourished children using daily evaluation of key clinical warning signs. BMC Med., 19.","DOI":"10.1186\/s12916-021-02074-6"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1203\/01.pdr.0000127017.44938.6d","article-title":"Whole-body leucine kinetics and the acute phase response during acute infection in marasmic Malawian children","volume":"55","author":"Manary","year":"2004","journal-title":"Pediatr. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1093\/ajcn\/82.4.792","article-title":"Protein kinetic differences between children with edematous and nonedematous severe childhood undernutrition in the fed and postabsorptive states","volume":"82","author":"Jahoor","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1093\/ajcn\/83.6.1283","article-title":"Lipid kinetic differences between children with kwashiorkor and those with marasmus","volume":"83","author":"Badaloo","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.3945\/jn.116.239145","article-title":"Metabolomic Changes in Serum of Children with Different Clinical Diagnoses of Malnutrition","volume":"146","author":"Bourdon","year":"2016","journal-title":"J. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"May, T., de la Haye, B., Nord, G., Klatt, K., Stephenson, K., Adams, S., Bollinger, L., Hanchard, N., Arning, E., and Bottiglieri, T. (2022). One-carbon metabolism in children with marasmus and kwashiorkor. EBioMedicine, 75.","DOI":"10.1016\/j.ebiom.2021.103791"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1079\/PNS19870008","article-title":"Free radicals in the pathogenesis of kwashiorkor","volume":"46","author":"Golden","year":"1987","journal-title":"Proc. Nutr. Soc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1179\/2046905515Y.0000000010","article-title":"Nutritional and other types of oedema, albumin, complex carbohydrates and the interstitium\u2014A response to Malcolm Coulthard\u2019s hypothesis: Oedema in kwashiorkor is caused by hypo-albuminaemia","volume":"35","author":"Golden","year":"2015","journal-title":"Paediatr. Int. Child. Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"5791","DOI":"10.1038\/s41467-019-13433-6","article-title":"Edematous severe acute malnutrition is characterized by hypomethylation of DNA","volume":"10","author":"Schulze","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S0140-6736(48)92087-X","article-title":"The essential pathology of kwashiorkor","volume":"251","author":"Davies","year":"1948","journal-title":"Lancet"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/0035-9203(72)90157-5","article-title":"The liver in pre-kwashiorkor and kwashiorkor-marasmus syndromes","volume":"66","author":"Chaudhuri","year":"1972","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"100199","DOI":"10.1016\/j.gpeds.2024.100199","article-title":"Hepatic mitochondrial and peroxisomal alterations in acutely ill malnourished Malawian children: A postmortem cohort study","volume":"9","author":"Ling","year":"2024","journal-title":"Glob. Pediatr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1080\/02724936.1987.11748510","article-title":"Serum carnitine in children with kwashiorkor","volume":"7","author":"Hammond","year":"1987","journal-title":"Ann. Trop. Paediatr."},{"key":"ref_51","first-page":"133","article-title":"Plasma free carnitine levels in children with malnutrition","volume":"36","author":"Tanzer","year":"1994","journal-title":"Turk. J. Pediatr."},{"key":"ref_52","first-page":"15","article-title":"Peroxisomes and the hepatic pathology of childhood malnutrition","volume":"43","author":"Brooks","year":"1994","journal-title":"West. Indian. Med. J."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Zhang, L., Voskuijl, W., Mouzaki, M., Groen, A.K., Alexander, J., Bourdon, C., Wang, A., Versloot, C.J., Di Giovanni, V., and Wanders, R.J. (2016). Impaired Bile Acid Homeostasis in Children with Severe Acute Malnutrition. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155143"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"737","DOI":"10.21037\/atm-20-5110","article-title":"The role of bile acids in cholestatic liver injury","volume":"9","author":"Cai","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"931","DOI":"10.3945\/jn.111.155960","article-title":"Nutritional repletion of children with severe acute malnutrition does not affect VLDL apolipoprotein B-100 synthesis rate","volume":"142","author":"Badaloo","year":"2012","journal-title":"J. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Kerac, M., Bunn, J., Chagaluka, G., Bahwere, P., Tomkins, A., Collins, S., and Seal, A. (2014). Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): A prospective cohort study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0096030"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Mody, A., Bartz, S., Hornik, C.P., Kiyimba, T., Bain, J., Muehlbauer, M., Kiboneka, E., Stevens, R., St Peter, J.V., and Newgard, C.B. (2014). Effects of HIV infection on the metabolic and hormonal status of children with severe acute malnutrition. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102233"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Gonzales, G.B., Njunge, J.M., Gichuki, B.M., Wen, B., Potani, I., Voskuijl, W., Bandsma, R.H.J., and Berkley, J.A. (2020). Plasma proteomics reveals markers of metabolic stress in HIV infected children with severe acute malnutrition. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-68143-7"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/nature13421","article-title":"Persistent gut microbiota immaturity in malnourished Bangladeshi children","volume":"510","author":"Subramanian","year":"2014","journal-title":"Nature"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ymben.2018.07.018","article-title":"Gut microbiota dysbiosis is associated with malnutrition and reduced plasma amino acid levels: Lessons from genome-scale metabolic modeling","volume":"49","author":"Kumar","year":"2018","journal-title":"Metab. Eng."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1126\/science.1229000","article-title":"Gut microbiomes of Malawian twin pairs discordant for kwashiorkor","volume":"339","author":"Smith","year":"2013","journal-title":"Science"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"aad3311","DOI":"10.1126\/science.aad3311","article-title":"Gut bacteria that prevent growth impairments transmitted by microbiota from malnourished children","volume":"351","author":"Blanton","year":"2016","journal-title":"Science"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1056\/NEJMoa2023294","article-title":"A Microbiota-Directed Food Intervention for Undernourished Children","volume":"384","author":"Chen","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Farras, M., Chandwe, K., Mayneris-Perxachs, J., Amadi, B., Louis-Auguste, J., Besa, E., Zyambo, K., Guerrant, R., Kelly, P., and Swann, J.R. (2018). Characterizing the metabolic phenotype of intestinal villus blunting in Zambian children with severe acute malnutrition and persistent diarrhea. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192092"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Hossain, M.S., Begum, S., Rahman, M.M., Parvez, M., Mazumder, R.N., Sarker, S.A., Hasan, M.M., Fahim, S.M., Gazi, M.A., and Das, S. (2023). Environmental enteric dysfunction and small intestinal histomorphology of stunted children in Bangladesh. PLoS Negl. Trop. Dis., 17.","DOI":"10.1371\/journal.pntd.0010472"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"S65","DOI":"10.1016\/j.ajcnut.2024.02.027","article-title":"Anthropometry relationship with duodenal histologic features of children with environmental enteric dysfunction: A multicenter cross-sectional study","volume":"120","author":"Jamil","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.3945\/ajcn.116.131797","article-title":"Protein- and zinc-deficient diets modulate the murine microbiome and metabolic phenotype","volume":"104","author":"Bolick","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e654","DOI":"10.1016\/S2214-109X(16)30133-4","article-title":"Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): A cohort study","volume":"4","author":"Lelijveld","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/ajcn\/26.2.205","article-title":"Excretion of catecholamines and catecholamine metabolites in kwashiorkor","volume":"26","author":"Hoeldtke","year":"1973","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/ajcn\/31.1.41","article-title":"Daily urinary catecholamine profile in marasmus and kwashiorkor","volume":"31","author":"Ramirez","year":"1978","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1038\/s41574-019-0280-9","article-title":"The effects of growth hormone on adipose tissue: Old observations, new mechanisms","volume":"16","author":"Kopchick","year":"2020","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s13679-019-00343-3","article-title":"FSP27 and Links to Obesity and Diabetes Mellitus","volume":"8","author":"Karki","year":"2019","journal-title":"Curr. Obes. Rep."},{"key":"ref_73","first-page":"936","article-title":"Growth hormone inhibits lipoprotein lipase activity in human adipose tissue","volume":"80","author":"Ottosson","year":"1995","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_74","first-page":"626","article-title":"Effects of physiological hypercortisolemia on the regulation of lipolysis in subcutaneous adipose tissue","volume":"83","author":"Samra","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1111\/dom.12899","article-title":"Acute physiological effects of glucocorticoids on fuel metabolism in humans are permissive but not direct","volume":"19","author":"Stimson","year":"2017","journal-title":"Diabetes Obes. Metab."},{"key":"ref_76","first-page":"3","article-title":"The Role of Leptin in Maintaining Plasma Glucose During Starvation","volume":"6","author":"Perry","year":"2018","journal-title":"Postdoc J."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.cell.2017.12.001","article-title":"Leptin Mediates a Glucose-Fatty Acid Cycle to Maintain Glucose Homeostasis in Starvation","volume":"172","author":"Perry","year":"2018","journal-title":"Cell"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"13670","DOI":"10.1073\/pnas.1901795116","article-title":"Leptin\u2019s hunger-suppressing effects are mediated by the hypothalamic-pituitary-adrenocortical axis in rodents","volume":"116","author":"Perry","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1172\/JCI200317490","article-title":"The role of falling leptin levels in the neuroendocrine and metabolic adaptation to short-term starvation in healthy men","volume":"111","author":"Chan","year":"2003","journal-title":"J. Clin. Investig."},{"key":"ref_80","first-page":"423","article-title":"Mechanisms behind decreased endogenous glucose production in malnourished children","volume":"68","author":"Bandsma","year":"2010","journal-title":"Pediatr. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1203\/00006450-198212000-00008","article-title":"Fasting pancreatic glucagon in Jamaican children during malnutrition and subsequent recovery","volume":"16","author":"Robinson","year":"1982","journal-title":"Pediatr. Res."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.cmet.2018.03.001","article-title":"Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1","volume":"27","author":"Drucker","year":"2018","journal-title":"Cell Metab."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.molmet.2019.09.010","article-title":"Glucagon-like peptide 1 (GLP-1)","volume":"30","author":"Muller","year":"2019","journal-title":"Mol. Metab."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"C1793","DOI":"10.1152\/ajpcell.00168.2025","article-title":"GLP-1 and ghrelin inversely regulate insulin secretion and action in pancreatic islets, vagal afferents, and hypothalamus for controlling glycemia and feeding","volume":"328","author":"Yada","year":"2025","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Liu, W.W., Reicher, N., Alway, E., Rupprecht, L.E., Weng, P., Schaefgen, C., Klein, M.E., Villalobos, J.A., Puerto-Hernandez, C., and Kiesling Altun, Y.G. (2025). A gut sense for a microbial pattern regulates feeding. Nature.","DOI":"10.1038\/s41586-025-09301-7"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"111038","DOI":"10.1016\/j.mce.2020.111038","article-title":"Effect of growth hormone on insulin signaling","volume":"518","author":"Sharma","year":"2020","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"94","DOI":"10.2337\/db11-0814","article-title":"Targeted loss of GHR signaling in mouse skeletal muscle protects against high-fat diet-induced metabolic deterioration","volume":"61","author":"Vijayakumar","year":"2012","journal-title":"Diabetes"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.2337\/diabetes.50.10.2301","article-title":"Pharmacological antilipolysis restores insulin sensitivity during growth hormone exposure","volume":"50","author":"Nielsen","year":"2001","journal-title":"Diabetes"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"5813","DOI":"10.1210\/jcem.86.12.8096","article-title":"Inhibition of the rise in FFA by Acipimox partially prevents GH-induced insulin resistance in GH-deficient adults","volume":"86","author":"Segerlantz","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1210\/er.2008-0027","article-title":"Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects","volume":"30","author":"Moller","year":"2009","journal-title":"Endocr. Rev."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/apha.12183","article-title":"Growth hormone-induced insulin resistance in human subjects involves reduced pyruvate dehydrogenase activity","volume":"210","author":"Nellemann","year":"2014","journal-title":"Acta Physiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.cell.2012.02.017","article-title":"Mechanisms for insulin resistance: Common threads and missing links","volume":"148","author":"Samuel","year":"2012","journal-title":"Cell"},{"key":"ref_93","first-page":"E499","article-title":"Growth hormone acutely stimulates forearm muscle protein synthesis in normal humans","volume":"260","author":"Fryburg","year":"1991","journal-title":"Am. J. Physiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1159\/000182593","article-title":"The effects of human growth hormone and prednisone on whole body estimates of protein metabolism","volume":"38","author":"Haymond","year":"1992","journal-title":"Horm. Res."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.clnu.2009.08.015","article-title":"Growth hormone and protein metabolism","volume":"28","author":"Moller","year":"2009","journal-title":"Clin. Nutr."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1172\/JCI108057","article-title":"Effect of ketone infusions on amino acid and nitrogen metabolism in man","volume":"55","author":"Sherwin","year":"1975","journal-title":"J. Clin. Investig."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1172\/JCI112339","article-title":"Inverse relationship of leucine flux and oxidation to free fatty acid availability in vivo","volume":"77","author":"Tessari","year":"1986","journal-title":"J. Clin. Investig."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1172\/JCI113570","article-title":"Effect of beta-hydroxybutyrate on whole-body leucine kinetics and fractional mixed skeletal muscle protein synthesis in humans","volume":"82","author":"Nair","year":"1988","journal-title":"J. Clin. Investig."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"4371","DOI":"10.1210\/jc.2003-030267","article-title":"The decisive role of free fatty acids for protein conservation during fasting in humans with and without growth hormone","volume":"88","author":"Norrelund","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"111052","DOI":"10.1016\/j.mce.2020.111052","article-title":"Effects of GH\/IGF axis on bone and cartilage","volume":"519","author":"Dixit","year":"2021","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s11914-020-00570-x","article-title":"The Actions of IGF-1 in the Growth Plate and Its Role in Postnatal Bone Elongation","volume":"18","author":"Racine","year":"2020","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.1210\/en.2014-1983","article-title":"Insulin-Like Growth Factor-Independent Effects of Growth Hormone on Growth Plate Chondrogenesis and Longitudinal Bone Growth","volume":"156","author":"Wu","year":"2015","journal-title":"Endocrinology"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1089\/met.2007.0029","article-title":"Physiological, pharmacological, and nutritional regulation of circulating adiponectin concentrations in humans","volume":"6","author":"Swarbrick","year":"2008","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1038\/s42255-019-0041-z","article-title":"Metabolic Messengers: Adiponectin","volume":"1","author":"Straub","year":"2019","journal-title":"Nat. Metab."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1210\/jc.2006-1683","article-title":"Modulation of adiponectin and leptin during refeeding of female anorexia nervosa patients","volume":"92","author":"Stein","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1530\/JOE-12-0505","article-title":"Adiponectin in mice with altered GH action: Links to insulin sensitivity and longevity?","volume":"216","author":"Lubbers","year":"2013","journal-title":"J. Endocrinol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/j.bbrc.2005.04.026","article-title":"Prolactin and growth hormone regulate adiponectin secretion and receptor expression in adipose tissue","volume":"331","author":"Nilsson","year":"2005","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"R107","DOI":"10.1530\/JME-13-0208","article-title":"Action of GH on skeletal muscle function: Molecular and metabolic mechanisms","volume":"52","author":"Chikani","year":"2014","journal-title":"J. Mol. Endocrinol."},{"key":"ref_109","first-page":"3","article-title":"Thyroid hormone actions in cartilage and bone","volume":"2","author":"Williams","year":"2013","journal-title":"Eur. Thyroid. J."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1002\/jbmr.5","article-title":"Thyroid hormone-mediated growth and differentiation of growth plate chondrocytes involves IGF-1 modulation of beta-catenin signaling","volume":"25","author":"Wang","year":"2010","journal-title":"J. Bone Min. Res."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/382250a0","article-title":"Role of leptin in the neuroendocrine response to fasting","volume":"382","author":"Ahima","year":"1996","journal-title":"Nature"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1172\/JCI0215693","article-title":"Beneficial effects of leptin on obesity, T cell hyporesponsiveness, and neuroendocrine\/metabolic dysfunction of human congenital leptin deficiency","volume":"110","author":"Farooqi","year":"2002","journal-title":"J. Clin. Investig."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1210\/jcem.87.5.8628","article-title":"Low dose leptin administration reverses effects of sustained weight-reduction on energy expenditure and circulating concentrations of thyroid hormones","volume":"87","author":"Rosenbaum","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.1210\/jc.2008-0056","article-title":"Leptin does not mediate short-term fasting-induced changes in growth hormone pulsatility but increases IGF-I in leptin deficiency states","volume":"93","author":"Chan","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1038\/s41366-021-00809-2","article-title":"Serum IGF1 and linear growth in children with congenital leptin deficiency before and after leptin substitution","volume":"45","author":"Beghini","year":"2021","journal-title":"Int. J. Obes."},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Tiwari, R., Ausman, L.M., and Agho, K.E. (2014). Determinants of stunting and severe stunting among under-fives: Evidence from the 2011 Nepal Demographic and Health Survey. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-239"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/mcn.12123","article-title":"The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania","volume":"11","author":"Sania","year":"2015","journal-title":"Matern. Child. Nutr."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1093\/ije\/dyt109","article-title":"Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries","volume":"42","author":"Christian","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1038\/s41586-023-06501-x","article-title":"Causes and consequences of child growth faltering in low-resource settings","volume":"621","author":"Mertens","year":"2023","journal-title":"Nature"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1179\/2046905514Y.0000000158","article-title":"The stunting syndrome in developing countries","volume":"34","author":"Prendergast","year":"2014","journal-title":"Paediatr. Int. Child. Health"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"112374","DOI":"10.1016\/j.socscimed.2019.112374","article-title":"Assessing associational strength of 23 correlates of child anthropometric failure: An econometric analysis of the 2015\u20132016 National Family Health Survey, India","volume":"238","author":"Kim","year":"2019","journal-title":"Soc. Sci. Med."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1001\/jama.2009.548","article-title":"Association of maternal height with child mortality, anthropometric failure, and anemia in India","volume":"301","author":"Subramanian","year":"2009","journal-title":"JAMA"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1093\/ajcn\/nqy326","article-title":"The relationship between wasting and stunting: A retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016","volume":"110","author":"Schoenbuchner","year":"2019","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/mcn.12231","article-title":"Childhood stunting: A global perspective","volume":"12","author":"Branca","year":"2016","journal-title":"Matern. Child. Nutr."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/jn\/nxx064","article-title":"Use and Misuse of Stunting as a Measure of Child Health","volume":"148","author":"Perumal","year":"2018","journal-title":"J. Nutr."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1038\/s41430-019-0439-4","article-title":"Stunting is not a synonym of malnutrition","volume":"74","author":"Scheffler","year":"2020","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1079\/BJN19860065","article-title":"Intestinal microflora, morphology and enzyme activity in zinc-deficient and Zn-supplemented rats","volume":"55","author":"Southon","year":"1986","journal-title":"Br. J. Nutr."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1146\/annurev.nu.05.070185.002013","article-title":"Clinical manifestations of zinc deficiency","volume":"5","author":"Prasad","year":"1985","journal-title":"Annu. Rev. Nutr."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1177\/1535370218758275","article-title":"Impacts of maternal dietary protein intake on fetal survival, growth, and development","volume":"243","author":"Herring","year":"2018","journal-title":"Exp. Biol. Med."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000449175","article-title":"The Rise and Fall of Protein Malnutrition in Global Health","volume":"69","author":"Semba","year":"2016","journal-title":"Ann. Nutr. Metab."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"20503121231165562","DOI":"10.1177\/20503121231165562","article-title":"Study of the importance of protein needs for catch-up growth in Indonesian stunted children: A narrative review","volume":"11","author":"Endrinikapoulos","year":"2023","journal-title":"SAGE Open Med."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1500S","DOI":"10.1093\/jn\/130.5.1500S","article-title":"The role of zinc in growth and cell proliferation","volume":"130","author":"MacDonald","year":"2000","journal-title":"J. Nutr."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3945\/ajcn.2008.26862","article-title":"Effects of micronutrients on growth of children under 5 y of age: Meta-analyses of single and multiple nutrient interventions","volume":"89","author":"Ramakrishnan","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Liu, E., Pimpin, L., Shulkin, M., Kranz, S., Duggan, C.P., Mozaffarian, D., and Fawzi, W.W. (2018). Effect of Zinc Supplementation on Growth Outcomes in Children under 5 Years of Age. Nutrients, 10.","DOI":"10.3390\/nu10030377"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s13312-019-1537-z","article-title":"Zinc Supplementation for Promoting Growth in Children Under 5 years of age in Low- and Middle-income Countries: A Systematic Review","volume":"56","author":"Gera","year":"2019","journal-title":"Indian. Pediatr."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1172\/JCI119207","article-title":"Interleukin 6 causes growth impairment in transgenic mice through a decrease in insulin-like growth factor-I. A model for stunted growth in children with chronic inflammation","volume":"99","author":"Alonzi","year":"1997","journal-title":"J. Clin. Investig."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"T35","DOI":"10.1530\/JME-14-0006","article-title":"Recent research on the growth plate: Impact of inflammatory cytokines on longitudinal bone growth","volume":"53","author":"Sederquist","year":"2014","journal-title":"J. Mol. Endocrinol."},{"key":"ref_138","doi-asserted-by":"crossref","unstructured":"Prendergast, A.J., Rukobo, S., Chasekwa, B., Mutasa, K., Ntozini, R., Mbuya, M.N., Jones, A., Moulton, L.H., Stoltzfus, R.J., and Humphrey, J.H. (2014). Stunting is characterized by chronic inflammation in Zimbabwean infants. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0086928"},{"key":"ref_139","first-page":"109","article-title":"mTORC1, the maestro of cell metabolism and growth","volume":"39","author":"He","year":"2025","journal-title":"Genes Dev."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"C804","DOI":"10.1152\/ajpcell.00183.2022","article-title":"Convergence of signaling pathways in mediating actions of leucine and IGF-1 on mTORC1 in L6 myoblasts","volume":"323","author":"Roberson","year":"2022","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"3296","DOI":"10.1210\/endo.139.7.6099","article-title":"Dexamethasone impairs growth hormone (GH)-stimulated growth by suppression of local insulin-like growth factor (IGF)-I production and expression of GH- and IGF-I-receptor in cultured rat chondrocytes","volume":"139","author":"Jux","year":"1998","journal-title":"Endocrinology"},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.cmet.2008.05.006","article-title":"Inhibition of growth hormone signaling by the fasting-induced hormone FGF21","volume":"8","author":"Inagaki","year":"2008","journal-title":"Cell Metab."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"26060","DOI":"10.1074\/jbc.M112.343707","article-title":"Fibroblast growth factor 21 (FGF21) inhibits chondrocyte function and growth hormone action directly at the growth plate","volume":"287","author":"Wu","year":"2012","journal-title":"J. Biol. Chem."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"nzz024","DOI":"10.1093\/cdn\/nzz024","article-title":"Plasma Fibroblast Growth Factor 21 Is Associated with Subsequent Growth in a Cohort of Underweight Children in Bangladesh","volume":"3","author":"Arndt","year":"2019","journal-title":"Curr. Dev. Nutr."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"114408","DOI":"10.1016\/j.jpeds.2024.114408","article-title":"Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia","volume":"277","author":"Lauer","year":"2025","journal-title":"J. Pediatr."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"911","DOI":"10.3945\/ajcn.112.052332","article-title":"Critical windows for nutritional interventions against stunting","volume":"97","author":"Prentice","year":"2013","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1210\/jc.2013-3511","article-title":"Glucose metabolism in adult survivors of severe acute malnutrition","volume":"99","author":"Thompson","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1002\/ajhb.20998","article-title":"Growth patterns in early childhood and final attained stature: Data from five birth cohorts from low- and middle-income countries","volume":"22","author":"Stein","year":"2010","journal-title":"Am. J. Hum. Biol."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1093\/jn\/136.9.2412","article-title":"Preschool stunting, adolescent migration, catch-up growth, and adult height in young senegalese men and women of rural origin","volume":"136","author":"Coly","year":"2006","journal-title":"J. Nutr."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1017\/S0007114522004056","article-title":"Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia","volume":"130","author":"Dumbura","year":"2023","journal-title":"Br. J. Nutr."},{"key":"ref_151","doi-asserted-by":"crossref","unstructured":"Wells, J.C.K. (2019). Body composition of children with moderate and severe undernutrition and after treatment: A narrative review. BMC Med., 17.","DOI":"10.1186\/s12916-019-1465-8"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.ajcnut.2024.12.014","article-title":"Associations of early childhood exposure to severe acute malnutrition and recovery with cardiometabolic risk markers in later childhood: 5-year prospective matched cohort study in Ethiopia","volume":"121","author":"Gizaw","year":"2025","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"e141316","DOI":"10.1172\/jci.insight.141316","article-title":"Childhood severe acute malnutrition is associated with metabolomic changes in adulthood","volume":"5","author":"Thompson","year":"2020","journal-title":"JCI Insight"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1093\/ajcn\/nqab034","article-title":"Severe acute malnutrition in childhood, chronic diseases, and human capital in adulthood in the Democratic Republic of Congo: The Lwiro Cohort Study","volume":"114","author":"Bisimwa","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_155","doi-asserted-by":"crossref","unstructured":"Mwene-Batu, P., Bisimwa, G., Donnen, P., Bisimwa, J., Tshongo, C., Dramaix, M., Hermans, M.P., and Briend, A. (2022). Risk of Chronic Disease after an Episode of Marasmus, Kwashiorkor or Mixed-Type Severe Acute Malnutrition in the Democratic Republic of Congo: The Lwiro Follow-Up Study. Nutrients, 14.","DOI":"10.3390\/nu14122465"},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1017\/S2040174422000034","article-title":"The effect of wasting and stunting during severe acute malnutrition in infancy on insulin sensitivity and insulin clearance in adult life","volume":"13","author":"Thompson","year":"2022","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1093\/aje\/kwk071","article-title":"Birth weight and subsequent risk of type 2 diabetes: A meta-analysis","volume":"165","author":"Harder","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1001\/jama.2008.886","article-title":"Birth weight and risk of type 2 diabetes: A systematic review","volume":"300","author":"Whincup","year":"2008","journal-title":"JAMA"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"4220","DOI":"10.2337\/db15-0494","article-title":"Sex Differences in the Association Between Birth Weight and Adult Type 2 Diabetes","volume":"64","author":"Zimmermann","year":"2015","journal-title":"Diabetes"},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/ppe.12831","article-title":"The association between late preterm birth and cardiometabolic conditions across the life course: A systematic review and meta-analysis","volume":"36","author":"Stone","year":"2022","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/ajcn\/nqaa346","article-title":"Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia","volume":"113","author":"Dumbura","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1093\/ajcn\/nqaa182","article-title":"Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: A systematic review and meta-analysis","volume":"112","author":"Karunaratne","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1038\/s41430-023-01320-9","article-title":"Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia","volume":"77","author":"Sturgeon","year":"2023","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_164","doi-asserted-by":"crossref","unstructured":"Sonego, M., Pellegrin, M.C., Becker, G., and Lazzerini, M. (2015). Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: A systematic review and meta-analysis of observational studies. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0116380"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.3945\/ajcn.116.130518","article-title":"Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: An observational cohort study","volume":"104","author":"Attia","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_166","doi-asserted-by":"crossref","unstructured":"Njunge, J.M., Gwela, A., Kibinge, N.K., Ngari, M., Nyamako, L., Nyatichi, E., Thitiri, J., Gonzales, G.B., Bandsma, R.H.J., and Walson, J.L. (2019). Biomarkers of post-discharge mortality among children with complicated severe acute malnutrition. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-42436-y"},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"e2020027003","DOI":"10.1542\/peds.2020-027003","article-title":"Clinical and Biochemical Markers of Risk in Uncomplicated Severe Acute Malnutrition","volume":"147","author":"Freemark","year":"2021","journal-title":"Pediatrics"},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.ajcnut.2024.05.029","article-title":"Clinical and biochemical responses to treatment of uncomplicated severe acute malnutrition: A multicenter observational cohort from the OptiDiag study","volume":"120","author":"Deng","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_169","doi-asserted-by":"crossref","unstructured":"Nalwanga, D., Musiime, V., Kiguli, S., Olupot-Olupot, P., Alaroker, F., Opoka, R., Tagoola, A., Mnjalla, H., Mogaka, C., and Nabawanuka, E. (2024). Is fat mass a better predictor of 6-month survival than muscle mass among African children aged 6-59 months with severe pneumonia?. BMC Nutr., 10.","DOI":"10.1186\/s40795-024-00939-6"},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/ije\/27.5.840","article-title":"Fatness and muscularity as risk indicators of child mortality in rural Congo","volume":"27","author":"Eeckels","year":"1998","journal-title":"Int. J. Epidemiol."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1038\/nrrheum.2016.209","article-title":"Leptin in the interplay of inflammation, metabolism and immune system disorders","volume":"13","author":"Abella","year":"2017","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Kiernan, K., and MacIver, N.J. (2020). The Role of the Adipokine Leptin in Immune Cell Function in Health and Disease. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.622468"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"E108","DOI":"10.1152\/ajpendo.00057.2011","article-title":"Short-term and long-term leptin exposure differentially affect human natural killer cell immune functions","volume":"302","author":"Wrann","year":"2012","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/j.1365-2249.2007.03491.x","article-title":"Leptin improves pulmonary bacterial clearance and survival in ob\/ob mice during pneumococcal pneumonia","volume":"150","author":"Hsu","year":"2007","journal-title":"Clin. Exp. Immunol."},{"key":"ref_175","doi-asserted-by":"crossref","unstructured":"Maurya, R., Bhattacharya, P., Dey, R., and Nakhasi, H.L. (2018). Leptin Functions in Infectious Diseases. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.02741"},{"key":"ref_176","doi-asserted-by":"crossref","unstructured":"Tsiotra, P.C., Boutati, E., Dimitriadis, G., and Raptis, S.A. (2013). High insulin and leptin increase resistin and inflammatory cytokine production from human mononuclear cells. Biomed. Res. Int., 2013.","DOI":"10.1155\/2013\/487081"},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1002\/eji.201343592","article-title":"Leptin deficiency impairs maturation of dendritic cells and enhances induction of regulatory T and Th17 cells","volume":"44","author":"Larocca","year":"2014","journal-title":"Eur. J. Immunol."},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/cmi.2009.46","article-title":"Leptin signaling protects NK cells from apoptosis during development in mouse bone marrow","volume":"6","author":"Lo","year":"2009","journal-title":"Cell Mol. Immunol."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0008-8749(03)00027-3","article-title":"Human leptin promotes survival of human circulating blood monocytes prone to apoptosis by activation of p42\/44 MAPK pathway","volume":"220","author":"Najib","year":"2002","journal-title":"Cell Immunol."},{"key":"ref_180","doi-asserted-by":"crossref","unstructured":"Sun, Z., Dragon, S., Becker, A., and Gounni, A.S. (2013). Leptin inhibits neutrophil apoptosis in children via ERK\/NF-kappaB-dependent pathways. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0055249"},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.jaci.2005.09.003","article-title":"Leptin is an eosinophil survival factor","volume":"116","author":"Conus","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.bbrc.2010.03.019","article-title":"Preferential effects of leptin on CD4 T cells in central and peripheral immune system are critically linked to the expression of leptin receptor","volume":"394","author":"Kim","year":"2010","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1677\/JOE-09-0179","article-title":"Leptin receptor is expressed in thymus medulla and leptin protects against thymic remodeling during endotoxemia-induced thymus involution","volume":"203","author":"Gruver","year":"2009","journal-title":"J. Endocrinol."},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1038\/s41390-020-1057-5","article-title":"Thymus size in children with moderate malnutrition: A cohort study from Burkina Faso","volume":"89","author":"Rytter","year":"2021","journal-title":"Pediatr. Res."},{"key":"ref_185","doi-asserted-by":"crossref","unstructured":"Nabukeera-Barungi, N., Lanyero, B., Grenov, B., Friis, H., Namusoke, H., Mupere, E., Michaelsen, K.F., Molgaard, C., Wiese, M., and Nielsen, D.S. (2021). Thymus size and its correlates among children admitted with severe acute malnutrition: A cross-sectional study in Uganda. BMC Pediatr., 21.","DOI":"10.1186\/s12887-020-02457-3"},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/tropej\/15.4.155","article-title":"Thymus weights in malnourished children","volume":"15","author":"Watts","year":"1969","journal-title":"J. Trop. Pediatr."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1172\/JCI6762","article-title":"Leptin protects mice from starvation-induced lymphoid atrophy and increases thymic cellularity in ob\/ob mice","volume":"104","author":"Howard","year":"1999","journal-title":"J. Clin. Investig."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"169","DOI":"10.4049\/jimmunol.177.1.169","article-title":"Leptin selectively augments thymopoiesis in leptin deficiency and lipopolysaccharide-induced thymic atrophy","volume":"177","author":"Hick","year":"2006","journal-title":"J. Immunol."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1007\/s10875-010-9507-1","article-title":"Leptin activates human B cells to secrete TNF-alpha, IL-6, and IL-10 via JAK2\/STAT3 and p38MAPK\/ERK1\/2 signaling pathway","volume":"31","author":"Agrawal","year":"2011","journal-title":"J. Clin. Immunol."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"101187","DOI":"10.1016\/j.xcrm.2023.101187","article-title":"High morbidity and mortality in children with untreated congenital deficiency of leptin or its receptor","volume":"4","author":"Saeed","year":"2023","journal-title":"Cell Rep. Med."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"3686","DOI":"10.1210\/jcem.84.10.5999","article-title":"Human leptin deficiency caused by a missense mutation: Multiple endocrine defects, decreased sympathetic tone, and immune system dysfunction indicate new targets for leptin action, greater central than peripheral resistance to the effects of leptin, and spontaneous correction of leptin-mediated defects","volume":"84","author":"Ozata","year":"1999","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_192","doi-asserted-by":"crossref","unstructured":"Fernandez-Pombo, A., Sanchez-Iglesias, S., Castro-Pais, A.I., Ginzo-Villamayor, M.J., Cobelo-Gomez, S., Prado-Morana, T., Diaz-Lopez, E.J., Casanueva, F.F., Loidi, L., and Araujo-Vilar, D. (2023). Natural history and comorbidities of generalised and partial lipodystrophy syndromes in Spain. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1250203"},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1210\/jc.2016-2271","article-title":"Clinical Features and Management of Non-HIV-Related Lipodystrophy in Children: A Systematic Review","volume":"102","author":"Gupta","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_194","doi-asserted-by":"crossref","unstructured":"Lima, J.G., Nobrega, L.H.C., Lima, N.N., Dos Santos, M.C.F., Silva, P.H.D., Baracho, M.F.P., Lima, D.N., de Melo Campos, J.T.A., Ferreira, L.C., and Freire Neto, F.P. (2018). Causes of death in patients with Berardinelli-Seip congenital generalized lipodystrophy. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0199052"},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"5120","DOI":"10.1210\/jc.2018-02730","article-title":"Comorbidities and Survival in Patients With Lipodystrophy: An International Chart Review Study","volume":"104","author":"Akinci","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1111\/dom.15061","article-title":"Clinical features of generalized lipodystrophy in Turkey: A cohort analysis","volume":"25","author":"Tuysuz","year":"2023","journal-title":"Diabetes Obes. Metab."},{"key":"ref_197","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/MPG.0000000000002633","article-title":"Glucagon-like Peptide 2 Concentrations Vary in Zambian Children During Diarrhoea, in Malnutrition and Seasonally","volume":"70","author":"Besa","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_198","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1113\/EP090492","article-title":"Potential determinants of low circulating glucagon-like peptide 2 concentrations in Zambian children with non-responsive stunting","volume":"108","author":"Besa","year":"2023","journal-title":"Exp. Physiol."},{"key":"ref_199","doi-asserted-by":"crossref","first-page":"eadh0673","DOI":"10.1126\/scitranslmed.adh0673","article-title":"Inflammation and epithelial repair predict mortality, hospital readmission, and growth recovery in complicated severe acute malnutrition","volume":"16","author":"Sturgeon","year":"2024","journal-title":"Sci. Transl. Med."},{"key":"ref_200","doi-asserted-by":"crossref","first-page":"5190","DOI":"10.1038\/s41467-024-49366-y","article-title":"Total and H-specific GDF-15 levels increase in caloric deprivation independently of leptin in humans","volume":"15","author":"Chrysafi","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_201","doi-asserted-by":"crossref","first-page":"100230","DOI":"10.1016\/j.jnha.2024.100230","article-title":"Growth differentiation factor 15 and malnutrition in older adults","volume":"28","author":"Rostami","year":"2024","journal-title":"J. Nutr. Health Aging"},{"key":"ref_202","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1146\/annurev-physiol-021115-105339","article-title":"Understanding the Physiology of FGF21","volume":"78","author":"Fisher","year":"2016","journal-title":"Annu. Rev. Physiol."},{"key":"ref_203","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.tem.2024.09.002","article-title":"GDF15 is still a mystery hormone","volume":"36","author":"Sigvardsen","year":"2025","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_204","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1056\/NEJMoa012437","article-title":"Leptin-replacement therapy for lipodystrophy","volume":"346","author":"Oral","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"329","DOI":"10.4274\/jcrpe.galenos.2022.2022-1-25","article-title":"Metreleptin Treatment in a Boy with Congenital Generalized Lipodystrophy due to Homozygous c.465_468delGACT (p.T156Rfs*8) Mutation in the BSCL2 Gene: Results from the First-year","volume":"15","author":"Ozalkak","year":"2023","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_206","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1210\/jc.2016-3628","article-title":"Effects of Metreleptin in Pediatric Patients With Lipodystrophy","volume":"102","author":"Brown","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.metabol.2003.10.019","article-title":"Changes in body composition in patients with severe lipodystrophy after leptin replacement therapy","volume":"53","author":"Moran","year":"2004","journal-title":"Metabolism"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/17\/2864\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:39:16Z","timestamp":1760035156000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/17\/2864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":207,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["nu17172864"],"URL":"https:\/\/doi.org\/10.3390\/nu17172864","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]}}}